A Prospective Clinical Study on Chronic Subdural Hematoma with Special Reference to Its Surgical Management at a Tertiary Care Hospital in North-East India

Abstract

BACKGROUND Chronic subdural hematoma (CSDH) is one of the commonest disease that affects elderly people. Presentation mimics many other diseases of elderly. Timely diagnosis and prompt surgical intervention is the key to favourable outcome. This study was done to obtain baseline data on its various modes of presentation and management in a tertiary care hospital in north east India. METHODS This prospective observational study was conducted at Assam Medical College and Hospital, Dibrugarh, Assam from June 2016 to end of May 2017. All radiologically confirmed patients with CSDH were included fulfilling the inclusion and exclusion criteria. All patients underwent surgical intervention as per indication. All patients were evaluated in regard of presenting clinical features, radiological findings, treatment received, peri-operative complications, outcome and other clinical variables during hospital stay and follow up. RESULTS A total of 52 patients were included in the study. Male and female ratio was 3: 1 and 73.08 % patients were aged more than 50 years. Headache was the most common symptom followed by altered sensorium, limb weakness, intermittent vomiting, convulsions and others. History of recent trauma was found in 67.31 % and chronic alcoholism in 28.85 % of patients. Most of the patient (63.46 %) had Glasgow coma scale (GCS) score 13 - 15. Pure CSDHs were found in 19.23 % and mixed density CSDHs in 80.77 % of patients. Burr hole was done in 48 patients (92.30 %) and craniotomy in 7 (13.46 %). Electrolyte imbalance was observed in 17.31 % of patients followed by seizures, pulmonary complications and others. Four patient had moderate disability at the time of discharge and at the end of one month all discharged patient had good recovery. CONCLUSIONS Chronic subdural hematoma is one the common benign disease of old age which requires high level of suspicion for diagnosis and early radiological investigation. Timely surgical intervention carries minimal risk of complications with good recovery for most of the patients. Burr hole is the preferred surgical procedure for CSDHs with craniotomy reserved for some selected cases. KEYWORDS Chronic Subdural Hematoma, Surgical Management, Burr Hole, Craniotomy